Health Care in the United States of America
Countries of the World
listed according to ranking of their national healthcare system...
Canadian Health Care System is Better than Obamacare
by Ralph Nader
Costly complexity is baked into Obamacare. No health insurance system is without problems but Canadian style single-payer full Medicare for all is simple, affordable, comprehensive and universal.
In the early 1960s, President Lyndon Johnson enrolled 20 million elderly Americans into Medicare in six months. There were no websites. They did it with index cards!
Below please find 21 Ways the Canadian Health Care System is Better than Obamacare.
Repeal Obamacare and replace it with the much more efficient single-payer, everybody in, nobody out, free choice of doctor and hospital.
Number 21: In Canada, everyone is covered automatically at birth – everybody in, nobody out.
In the United States, under Obamacare, 31 million Americans will still be uninsured by 2023 and millions more will remain underinsured.
Number 20: In Canada, the health system is designed to put people, not profits, first.
In the United States, Obamacare will do little to curb insurance industry profits and will actually enhance insurance industry profits.
Number 19: In Canada, coverage is not tied to a job or dependent on your income – rich and poor are in the same system, the best guaranty of quality.
In the United States, under Obamacare, much still depends on your job or income. Lose your job or lose your income, and you might lose your existing health insurance or have to settle for lesser coverage.
Number 18: In Canada, health care coverage stays with you for your entire life.
In the United States, under Obamacare, for tens of millions of Americans, health care coverage stays with you for as long as you can afford your share.
Number 17: In Canada, you can freely choose your doctors and hospitals and keep them. There are no lists of “in-network” vendors and no extra hidden charges for going “out of network.”
In the United States, under Obamacare, the in-network list of places where you can get treated is shrinking – thus restricting freedom of choice – and if you want to go out of network, you pay for it.
Number 16: In Canada, the health care system is funded by income, sales and corporate taxes that, combined, are much lower than what Americans pay in premiums.
In the United States, under Obamacare, for thousands of Americans, it’s pay or die – if you can’t pay, you die. That’s why many thousands will still die every year under Obamacare from lack of health insurance to get diagnosed and treated in time.
Number 15: In Canada, there are no complex hospital or doctor bills. In fact, usually you don’t even see a bill.
In the United States, under Obamacare, hospital and doctor bills will still be terribly complex, making it impossible to discover the many costly overcharges.
Number 14: In Canada, costs are controlled. Canada pays 10 percent of its GDP for its health care system, covering everyone.
In the United States, under Obamacare, costs continue to skyrocket. The U.S. currently pays 18 percent of its GDP and still doesn’t cover tens of millions of people.
Number 13: In Canada, it is unheard of for anyone to go bankrupt due to health care costs.
In the United States, under Obamacare, health care driven bankruptcy will continue to plague Americans.
Number 12: In Canada, simplicity leads to major savings in administrative costs and overhead.
In the United States, under Obamacare, complexity will lead to ratcheting up administrative costs and overhead.
Number 11: In Canada, when you go to a doctor or hospital the first thing they ask you is: “What’s wrong?”
In the United States, the first thing they ask you is: “What kind of insurance do you have?”
Number 10: In Canada, the government negotiates drug prices so they are more affordable.
In the United States, under Obamacare, Congress made it specifically illegal for the government to negotiate drug prices for volume purchases, so they remain unaffordable.
Number 9: In Canada, the government health care funds are not profitably diverted to the top one percent.
In the United States, under Obamacare, health care funds will continue to flow to the top. In 2012, CEOs at six of the largest insurance companies in the U.S. received a total of $83.3 million in pay, plus benefits.
Number 8: In Canada, there are no necessary co-pays or deductibles.
In the United States, under Obamacare, the deductibles and co-pays will continue to be unaffordable for many millions of Americans.
Number 7: In Canada, the health care system contributes to social solidarity and national pride.
In the United States, Obamacare is divisive, with rich and poor in different systems and tens of millions left out or with sorely limited benefits.
Number 6: In Canada, delays in health care are not due to the cost of insurance.
In the United States, under Obamacare, patients without health insurance or who are underinsured will continue to delay or forgo care and put their lives at risk.
Number 5: In Canada, nobody dies due to lack of health insurance.
In the United States, under Obamacare, many thousands will continue to die every year due to lack of health insurance.
Number 4: In Canada, an increasing majority supports their health care system, which costs half as much, per person, as in the United States. And in Canada, everyone is covered.
In the United States, a majority – many for different reasons – oppose Obamacare.
Number 3: In Canada, the tax payments to fund the health care system are progressive – the lowest 20 percent pays 6 percent of income into the system while the highest 20 percent pays 8 percent.
In the United States, under Obamacare, the poor pay a larger share of their income for health care than the affluent.
Number 2: In Canada, the administration of the system is simple. You get a health care card when you are born. And you swipe it when you go to a doctor or hospital. End of story.
In the United States, Obamacare’s 2,500 pages plus regulations (the Canadian Medicare Bill was 13 pages) is so complex that then Speaker of the House Nancy Pelosi said before passage “we have to pass the bill so that you can find out what is in it.”
Number 1: In Canada, the majority of citizens love their health care system.
In the United States, the majority of citizens, physicians, and nurses prefer the Canadian type system – single-payer, free choice of doctor and hospital , everybody in, nobody out.
For more information see Single Payer Action.
Cuba has become a world-class medical powerhouse with very limited resources, while "the US squanders perhaps 10 to 20 times what is needed for a good, affordable medical system." As a result, the Cuban infant mortality rate is "below that of the US and less than half that of US Blacks," and Americans can hardly claim to have a health care system.
Cuba ' s Health Care System the Best Model for Poor Countries?
by Don Fitz
" Cuban-trained doctors know their patients by knowing their patients ' communities."
Furious though it may be, the current debate over health care in the US is largely irrelevant to charting a path for poor countries of Africa, Latin America, Asia and the Pacific Islands. That is because the US squanders perhaps 10 to 20 times what is needed for a good, affordable medical system . The waste is far more than 30% overhead by private insurance companies. It includes an enormous amount of over-treatment, making the poor sicker by refusing them treatment, creation of illnesses, exposure to contagion through over-hospitalization, and disease-focused instead of prevention-focused research. 
Poor countries simply cannot afford such a health system. Well over 100 countries are looking to the example of Cuba, which has the same 78-year life expectancy of the US while spending 4% per person annually of what the US does. 
The most revolutionary idea of the Cuban system is doctors living in the neighborhoods they serve. A doctor-nurse team is part of the community and know their patients well because they live at (or near) the consultorio (doctors ' office) where they work. Consultorios are backed up by policlínicos which provide services during off-hours and offer a wide variety of specialists. Policlínicos coordinate community health delivery and link nationally designed health initiatives with their local implementation.
Cubans call their system medicina general integral (MGI, comprehensive general medicine). Its programs focus on preventing people from getting diseases rather than curing them after they are sick
This has made Cuba extremely effective in control of everyday health issues. Having doctors ' offices in every neighborhood has brought the Cuban infant mortality rate below that of the US and less than half that of US Blacks.  Cuba has a record unmatched in dealing with chronic and infectious diseases with amazingly limited resources. These include (with date eradicated): polio (1962), malaria (1967), neonatal tetanus (1972), diphtheria (1979), congenital rubella syndrome (1989), post-mumps meningitis (1989), measles (1993), rubella (1995), and TB meningitis (1997). 
" Programs focus on preventing people from getting diseases rather than curing them after they are sick."
The MGI integration of neighborhood doctors ' offices with area clinics and a national hospital system also means the country responds well to emergencies. It has the ability to evacuate entire cities during a hurricane largely because consultorio staff know everyone in their neighborhood and who to call for help getting disabled residents out of harms way. At the same time New York City (roughly the same population as Cuba) had 43,000 cases of AIDS, Cuba had 200 AIDS patients.  More recent emergencies such as outbreaks of dengue fever are quickly followed by national mobilizations. 
Perhaps the most amazing aspect of Cuban medicine it that, despite its being a poor country itself, Cuba has sent over 124,000 health care professionals to provide care to 154 countries.  In addition to providing preventive medicine Cuba sends response teams following emergencies (such as earthquakes and hurricanes) and has over 20,000 students from other countries studying to be doctors at its Latin American School of Medicine in Havana (ELAM, Escuela Latinoamericana de Medicina). 
In a recent Monthly Review article, I gave in-depth descriptions of ELAM students participating in Cuban medical efforts in Haiti, Ghana and Peru.  What follows are 10 generalizations from Cuba ' s extensive experience in developing medical science and sharing its approach with poor countries throughout the world. The concepts form the basis of the New Global Medicine and summarize what many authors have observed in dozens of articles and books.
First, it is not necessary to focus on expensive technology as the initial approach to medical care. Cuban doctors use machines that are available, but they have an amazing ability to treat disaster victims with field surgery. They are very aware that most lives are saved through preventive medicine such as nutrition and hygiene and that traditional cultures have their own healing wisdom. This is in direct contrast to Western medicine, especially as is dominant in the US, which uses costly diagnostic and treatment techniques as the first approach and is contemptuous of natural and alternative approaches.
" At the same time New York City (roughly the same population as Cuba) had 43,000 cases of AIDS, Cuba had 200 AIDS patients."
Second, doctors must be part of the communities where they are working. This could mean living in the same neighborhood as a Peruvian consultorio. It could mean living in a Venezuelan community that is much more violent than a Cuban one. Or it could mean living in emergency tents adjacent to where victims are housed as Cuban medical brigades did after the 2010 earthquake in Haiti. Or staying in a village guesthouse in Ghana. Cuban-trained doctors know their patients by knowing their patients ' communities. This differs sharply from US doctors, who receive zero training on how to assess homes of their patients.
Third, the MGI model outlines relationships between people that go beyond a set of facts. Instead of memorizing mountains of information unlikely to be used in community health, which US students must do to pass medical board exams, Cuban students learn what is necessary to relate to people in consultorios, polyclínicos, field hospitals and remote villages. Far from being nuisance courses, studies in how people are bio-psycho-social beings are critical for the everyday practice of Cuban medicine.
Fourth, the MGI model is not static but is evolving and unique for each community. Western medicine searches for the correct pill for a given disease. In its rigid approach, a major reason for research is to discover a new pill after " side effects " of the first pill surface. Since traditional medicine is based on the culture where it has existed for centuries, the MGI model avoids the futility of seeking to impose a Western mindset on other societies.
Fifth, it is necessary to adapt medical aid to the political climate of the host country. This means using whatever resources the host government is able and willing to offer and living with restrictions. Those hosting a Cuban medical brigade may be friendly as in Venezuela and Ghana, hostile as is the Brazilian Medical Association, become increasingly hostile as occurred after the 2009 coup in Honduras, or change from hostile to friendly as occurred in Peru with the 2011 election of Ollanta Humala. This is quite different from US medical aide which, like its food aide, is part of an overall effort to dominate the receiving country and push it into adopting a Western model.
Sixth, the MGI model creates the basis for dramatic health effects. Preventive community health training, a desire to understand traditional healers, the ability to respond quickly to emergencies, and an appreciation of political limitations give Cuban medical teams astounding success. During the first 18 months of Cuba ' s work in Honduras following Hurricane Mitch, infant mortality dropped from 80.3 to 30.9 per 1000 live births. When Cuban health professionals intervened in Gambia, malaria decreased from 600,000 cases in 2002 to 200,000 two years later. And Cuban/Venezuelan collaboration resulted in 1.5 million vision corrections by 2009. Kirk and Erisman conclude that " almost 2 million people throughout the world " owe their very lives to the availability of Cuban medical services. " 
" US medical aide which, like its food aide, is part of an overall effort to dominate the receiving country."
Seventh, the New Global Medicine can become reality only if medical staff put healing above personal wealth. In Cuba, being a doctor, nurse or support staff and going on a mission to another country is one of the most fulfilling activities a person can do. The program continues to find an increasing number of volunteers despite the low salaries that Cuban health professionals earn. There is definitely a minority of US doctors who focus their practice in low income communities which have the greatest need. But there is no political leadership which makes a concerted effort to get physicians to do anything other than follow the money.
Eighth, dedication to the New Global Medicine is now being transferred to the next generation. When students at Cuban schools learn to be doctors, dentists or nurses their instructors tell them of their own participation in health brigades in Angola, Peru, Haiti, Honduras and dozens of other countries. Venezuela has already developed its own approach of MIC (medicina integral communitaria, comprehensive community medicine) which builds upon but is distinct from Cuban MGI.  Many ELAM students who work in Ghana as the Yaa Asantewaa Brigade are from the US. They learn approaches of traditional healers so they can compliment Ghanaian techniques with Cuban medical knowledge.
Ninth, the Cuban model is remaking medicine across the globe. Though best-known for its successes in Latin America, Africa and the Caribbean, Cuba has also provided assistance in Asia and the Pacific Islands. Cuba provided relief to the Ukraine after the 1986 Chernobyl meltdown, Sri Lanka following the 2004 tsunami, and Pakistan after its 2005 earthquake. Many of the countries hosting Cuban medical brigades are eager for them to help redesign their own health care systems. Rather than attempting to make expensive Western techniques available to everyone, the Cuban MGI model helps re-conceptualize how healing systems can meet the needs of a country ' s poor.
" Many ELAM students who work in Ghana as the Yaa Asantewaa Brigade are from the US."
Tenth, the new global medicine is a microcosm of how a few thousand revolutionaries can change the world. They do not need vast riches, expensive technology, or a massive increase in personal possessions to improve the quality of people ' s lives. If dedicated to helping people while learning from those they help, they can prefigure a new world by carefully utilizing the resources in front of them. Such revolutionary activity helps show a world facing acute climate change that it can resolve many basic human needs without pouring more CO2 into the atmosphere.
Discussions of global health in the West typically bemoan the indisputable fact that poor countries still suffer from chronic and infectious diseases that rich countries have controlled for decades. International health organizations wring their hands over the high infant mortality rates and lack of resources to cope with natural disasters in much of the world. 
But they ignore the one health system that actually functions in a poor country, providing health care to all of its citizens as well as millions of others around the world. The conspiracy of silence surrounding the resounding success of Cuba ' s health system proves the absolute unconcern by those who piously claim to be the most concerned.
How should progressives respond to this feigned ignorance of a meaningful solution to global health problems? A rational response must begin with spreading the word of Cuba ' s New Global Medicine through every source of alternative media available. The message needs to be: Good health care is not more expensive -- revolutionary medicine is far more cost effective than corporate controlled medicine.
Don Fitz ( firstname.lastname@example.org ) is editor of Synthesis/Regeneration: A Magazine of Green Social Thought. He is Co-Coordinator of the Green Party of St. Louis and produces Green Time in conjunction with KNLC-TV 24.
US Health Care Debate: From the Sublime to the Ridiculous
The American debate sounds absurd (and heartless) to the rest of the industrialized world
by David Morris
Nowhere is the phrase American Exceptionalism more appropriately used than when describing our debate over health care. Outside the bubble that is the United States health care is viewed as a right, recognition that sickness and injury can strike anyone and an acknowledgement of a basic obligation civilized societies have to its members.
Among the highly-industrialized, the United States stands out for having so many of its political leaders argue that healthcare is some kind privilege -- a commodity that seeks profit -- and not a right granted to all.
If members of those societies were to tune in to the American debate I suspect they’d be baffled to watch grown men and women come up with ingenious ways to complicate a very simple moral issue.
Consider Richard Epstein’s response to the Supreme Court’s decision to uphold most of the health reform law. Epstein, an influential law professor at the University of Chicago chided Chief Justice Roberts in the New York Times for relying on Congress’ Constitutional power to “lay and collect Taxes.” He reminds us that the Constitution restricts the use of that power solely “to pay the Debts and provide for the common Defence (sic) and general Welfare of the United States.” And he insists that extending health care to 30 million Americans does not meet this standard because “general welfare” means “benefits that must be given to all citizens, if given to any.” That is, he explains, “matters that advance the welfare of the United States as a whole.”(Italics in the original)
Extending health care to 30 million does not enhance the general welfare, argues Epstein, because it does not extend health care to all 330 million Americans.
Now consider the argument by the Chief Justice Roberts and a majority of the Supreme Court who voted to strike down the law’s provisions regarding states’ expanding Medicaid. Under existing law the Secretary of Health and Human Services has the right to withdraw Medicaid funding from any state that does not meet minimum standards of access and coverage. The new law gave the Secretary the authority to strip states of their existing Medicaid funding if they do not expand Medicaid. The Court struck down this provision, arguing, “the expansion accomplishes a shift in kind, not merely degree. The original program was designed to cover medical services for particular categories of vulnerable individuals. Under the Affordable Care Act, Medicaid is transformed into a program to meet the health care needs of the entire non-elderly population with income below 133 percent of the poverty level.”
To review. To Richard Epstein, the entire health law is unconstitutional because it provides health insurance to too few. To John Roberts and most of the Supreme Court, part of the law is unconstitutional because it provides health care to too many.
Or consider how the New York Times reported on an Oregon health study a few days after the Court’s decision. The study was noteworthy because of its laboratory-like conditions. In 2008 Oregon opened its Medicaid rolls to working age adults living in poverty. Lacking the money to cover everyone, the state established a lottery. About 17,000 people won the lottery. The randomness with which they were selected made this a perfect setting for a study comparing insured and uninsured.
The Times offered some glimpses into how the lives of those who gained access to health insurance dramatically improved. “When Wendy Parris shattered her ankle, the emergency room put it in an air cast and sent her on her way. Because she had no insurance, doctors did not operate to fix it. A mother of six, Ms. Parris hobbled around for four years, pained by the foot, becoming less mobile and gaining weight.”
“After winning the health insurance lottery, Ms. Parris received surgery for her foot, and additional care. She is also getting spinal surgery. Doctors have helped her address her depression, triggered by the death of one of her children. Her weight has come back down, and her mobility is far better. ‘It saved my life,’ she said.” On average, those who were added to the Medicaid rolls were 25 percent less likely to have an unpaid medical bill sent to a collection agency. Forty percent were less likely to borrow money or skip paying other bills in order to cover their medical costs.
Nevertheless the Times concludes, “For the nation, the lesson appears to be mixed.” Mixed? Why? “Expanded coverage brings large benefits to many people, but it is also more likely to increase a stretched federal government’s long-term budget responsibilities.” Katherine Baicker, a Harvard economist who worked on the study and served as an economic adviser to President George W. Bush announced, “It’s up to society to determine whether it’s worth the cost.” What a strange calculus we who live inside the bubble use to determine whether we should care for one another.
A 2007 study by researchers at the Harvard Medical School found that 62 percent of US bankruptcies were a result of medical expenses)00404-5/abstract. Equally damning, 75 percent of the people with a medically related bankruptcy had health insurance.
How does this woeful statistic compare to other countries? It doesn’t. On PBS Frontline veteran reporter T.R. Reid asked the President of the Swiss Federation, Pascal Couchepin, “How many people in Switzerland go bankrupt because of medical bills?” Couchepin responded, “ Nobody. It doesn’t happen. It would be a huge scandal if it happens.”
To The Ridiculous
Sometimes our uniquely American every man for himself and the devil take the hindmost attitude degenerates into caricature. Watch this exchange between Senator Debbie Stabenow and Senator Jon Kyl during a Congressional hearing on health reform, and weep.
Stabenow (D-MI), “I don’t think you can go forward and allow 60% of the insurance companies not to provide basic maternity care in a new system we’re setting that hopefully will be better than the old one.”
Kyl (R-AZ), “First of all, I don’t need maternity care and so requiring that to be in my insurance policy is something that I don’t need and will make the policy more expensive.”
Laugh if you will at the absurdity of Kyl’s comment, then remember that the law’s requirement that all of us pay for health insurance was a key reason the Republicans took over the House and almost the Senate, while capturing more than 15 state legislatures in 2010.
Or watch again the famous (infamous?) Republican primary debate where host Wolf Blitzer posed a hypothetical question to Congressman Ron Paul, who is also a physician. As reported in the Los Angeles Times:
“A healthy, 30-year-old young man has a good job, makes a good living, but decides: You know what? I’m not going to spend 200 or 300 dollars a month for health insurance, because I’m healthy; I don’t need it,” Blitzer said. “But you know, something terrible happens; all of a sudden, he needs it. Who’s going to pay for it, if he goes into a coma, for example? Who pays for that?”
“In a society (in which) you accept welfarism and socialism, he expects the government to take care of him,” Paul replied. Blitzer asked what Paul would prefer to having government deal with the sick man.
“What he should do is whatever he wants to do, and assume responsibility for himself,” Paul said. ”My advice to him would have a major medical policy, but not before —”
“But he doesn’t have that,” Blitzer said. “He doesn’t have it and he’s — and he needs — he needs intensive care for six months. Who pays?”
“That’s what freedom is all about: taking your own risks,” Paul said, repeating the standard libertarian view as some in the audience cheered.
“But congressman, are you saying that society should just let him die,” Blitzer asked.
“Yeah,” came the shout from the audience. That affirmative was repeated at least three times.
Health Care Outside the American Bubble
A snapshot of health care outside the bubble might help put the American debate in context. This from a letter a friend who lives half the year in Paris wrote me last year:
“My general practitioner in Paris answers his own telephone, or his psychiatrist wife does and passes the message. He calls after he has seen me to ask how I’m feeling. When I’m very sick he gives his cell phone no. and asks me to call him on the weekend when he is out of town and if I forget, he calls me. He comes into the waiting room himself to bring patients into his office. He sees patients out to the street door. If it’s raining and you’re sick he dials for a taxi. Himself.”
“A service called SOS Medecins is available at any hour of the night and a doctor will appear at the door within fifteen or twenty minutes. I have been given a cardiogram in my bed at three a.m. ($80.00) I have been given an anti nausea shot at two am. The cost of these doctors’ visits $75.00. Visiting nurses are available in every neighborhood and come to administer antibiotic shots, or change bandages, with a doctor’s prescription. The cost is about $15.00 a visit.”
“Billing is done by the doctor or the specialist at his desk on his computer or in longhand while you are there. His office desk and the examining table are in the same room. There is often a receptionist, never a nurse or a secretary.”
The next day my friend sent me a P.S.
“Costs listed for medical care here were before any social coverage. I don’t have the ‘social’ because I’m not a citizen, have never worked here and don’t pay French taxes. With the ‘social’, payments are a fraction of that cost. When I pick up prescriptions for my friend and neighbor who is 87, I flash her card and pay them nothing.”
Inside the bubble we would describe the French health care system as socialist, a system to be condemned and avoided at all costs. Outside the United States it’s the way civilized societies morally behave.
This work is licensed under a Creative Commons License
David Morris is Vice President and director of the New Rules Project at the Institute for Local Self-Reliance, which is based in Minneapolis and Washington, D.C. focusing on local economic and social development.